Issues rarely black and white (commentary)

Issues rarely black and white (commentary)

WE all can name some music that we never got tired of listening to. For me, Billy Joel's River of Dreams album holds that distinction. My compulsion resulted in my pickup wearing out more than one cassette tape over the years (thank goodness for digital format).

The album contains a song titled, "Shades of Grey." Part of the lyrics are as follows: "Shades of grey wherever I go, the more I find out the less that I know; black and white is how it should be, but shades of grey are the colors I see."

Sure, the lyrics reference bigger issues about our respective belief systems and worldviews, but the principles also pertain to all issues for which perspectives can vary.

I was reminded of those lyrics at the tail end of 2013 following the Food & Drug Administration's announcement of "implementing a voluntary plan with industry to phase out the use of certain antibiotics for enhanced food production."

The plan has largely met with sharp criticism from various activist sources.

New York Times food columnist Mark Bittman's response ("The F.D.A.'s Not-Really-Such-Good-News") was especially antagonistic. Predictably, Bittman anchored his contention that FDA has fallen short of its responsibility to curb antibiotic use in animal agriculture on the 80% talking point — the claim that 80% of antibiotics sold in the U.S. are for use in animal agriculture. He then argued, "Technically, reducing antibiotic use is simple. The science tells us it is the thing to do."

Never mind that Bittman has no real background in either livestock production or public health.

On the heels of that column, CNN published an op-ed, authored by Rep. Louise Slaughter (D., N.Y.) and Dr. Robert Lawrence of John Hopkins University, titled "How a Cow Could Kill You: New Antibiotic Guidelines Still Fail to Protect Public."

The core of the authors' FDA rebuke is drawn directly from the Centers for Disease Control & Prevention's antibiotic resistance report published earlier this fall saying CDC "reported in October that antibiotic-resistant bacteria — known as 'superbugs' — cause at least 2 million infections and 23,000 deaths in the United States yearly."

They further contend that in 1977, FDA "found that feeding antibiotics to food animals at low doses, both to promote growth and to prevent disease, contributes to this public health crisis. The CDC concurred: '[M]uch of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe.'"

Slaughter and Lawrence, of course, similarly rely on the 80% talking point, writing, "It is difficult to fathom why the FDA expects the drug industry to voluntarily reduce its sales when 80% of the antibiotics sold in the United States are sold for use on the farm."

While Bittman completely overlooks the complexities involved in the science associated with antimicrobial resistance (AMR), Slaughter and Lawrence conveniently avoid it altogether.

Bittman would have us believe that AMR wouldn't occur if we simply made the use of antibiotics in livestock illegal.

Meanwhile, Slaughter and Lawrence fail to divulge to readers the rest of the story, which is that the same CDC report from which they quote also includes the following: "Antibiotics are among the most commonly prescribed drugs used in human medicine. However, up to 50% of all the antibiotics prescribed for people are not needed or are not optimally effective as prescribed."

Indeed, CDC estimates that AMR results in at least 23,000 deaths annually. However, Slaughter and Lawrence failed to highlight CDC's explanation that more than 60% of those deaths are directly attributable to Clostridium difficile, which is one of three urgent threats outlined by CDC as "a unique bacterial infection that, although not significantly resistant to the drugs used to treat it, is directly related to antibiotic use and resistance" (the qualifier being human medicine, not veterinary medicine).

Meanwhile, the other two urgent threats outlined by CDC include: (1) Carbapenem-resistant Enterobacteriaceae, which typically occurs in patients using various devices (e.g., ventilators) or taking long courses of antibiotics, and (2) drug-resistant Neisseria gonorrhoeae (no explanation needed in the case of venereal diseases).

That issue brings us full circle to the view that "black and white is how it should be."

Some activists seem to be focused on a single outcome: Remove antibiotics from the livestock industry. Sure, politically, that might score a victory in a black-and-white world, but it fails to comprehensively protect public health.

The reality is that when it comes to AMR and protecting the public, the science is complicated and, thus, continues to evolve; hence, "the more I find out, the less that I know."

Did FDA provide the full answer? Of course not. There's lots of work ahead. One thing's for certain, though. Given the complexities associated with AMR, meaningful solutions aren't derived from simply pointing fingers or placing blame; they're generated only by working together.

*Dr. Nevil C. Speer is with Western Kentucky University and serves on the board of the National Institute for Animal Agriculture, a national organization devoted to engaging livestock producers and livestock health professionals in developing solutions for issues in the livestock industry.

Volume:86 Issue:02

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